What to do in case of refusal of care or abusive fees?

What is a discriminatory denial of care?

Discriminatory denial of care refers to the practice of preventing or deterring a person from accessing preventive or care measures, by any means. These may include barriers to access to the healthcare professional or to normal conditions of financial responsibility for the health services, benefits and products.

According to the Penal Code, the grounds of discrimination are: origin, sex, family status, pregnancy, physical appearance, a particular vulnerability resulting from the patient's economic situation, surname, place of residence, state of health, loss of autonomy, disability, genetic characteristics, morals, sexual orientation, gender identity, age, political opinions, trade union activities, ability to express oneself in a language other than French, membership or non-membership (real or perceived) of a particular ethnicity, nation, race or religion.

Denial of care to a beneficiary of Universal Health Coverage (UHC), Supplementary Solidarity Health (CSS) or State Medical Aid (AME) is also considered discriminatory.

The conciliation procedure

There are joint conciliation boards that are specific to each health profession that deal with patient complaints. They are made up of representatives of the Caisse locale d'Assurance Maladie (CPAM) and the Conseil national de l'Ordre des médecins (CDOM).

A person who considers himself a victim of a discriminatory refusal of care shall submit a complaint to the Director of the CPAM or the President of the CDOM, who shall inform the practitioner concerned.

It shall state its own identity and contact details, identify the health-care professional in question and describe the facts complained of. This complaint is subject to a conciliation procedure.

During this conciliation, the victim may be assisted or represented by a person of his choice (in particular by an approved association), as well as the professional. If this is not possible, the parties may send their comments in writing to the secretariat of the commission, stating the reasons for the failure to do so.

Exceptionally, if all participants cannot be brought together and if the parties agree, conciliation may take place by videoconference or by conference call guaranteeing the confidentiality of the exchanges.

At the end of the meeting:

• the commission shall establish the conciliation and then bring the dispute to an end;
• there is no conciliation (the complainant does not withdraw his complaint or at least one of the parties did not respond to the summons). The remaining points of disagreement are then entered in the record of the sitting which is transmitted to each of the parties, to the Director of the CPAM and to the President of the CDOM. The complaint is then brought before the disciplinary chambers of the CDOM.

What is an illegal or abusive fee overrun?

The text specifies that an illegal or abusive overshoot corresponds to a failure to comply with the

tact and measurement

. In order to evaluate it, it is examined whether the fees have been set taking into account the complexity of the act performed, the time spent, the service rendered to the patient, the reputation of the practitioner, the percentage of acts with exceedance or the average amount of exceedances performed, for a comparable activity with the health professionals practicing in the same department or in the same administrative region.

Unlawful or abusive fee overruns are subject to penalty without conciliation.

Sanctions

• For discriminatory denial of care: A financial penalty equal to 2 times the monthly social security ceiling.
• For illegal overruns: a penalty equivalent to 2 times the amount of overruns invoiced.
  In the event of a repeat offense, the health professional may be prohibited from exceeding the limit for three years and may suspend the contribution to the financing of his social contributions.

The professional's sentence may be displayed in the CPAM's public reception area for a period of 1 to 3 months following the notification of the sanction.

In the event of a repeat offense and after all remedies have been exhausted, the Director of the CPAM may publish this penalty in any publication with local, departmental or regional circulation.